Michael R Dawdy, David W Munter, Roger A Gilmore
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90078-4
Published in issue: March 1997
xThis study was designed to examine the relationship between patient entry rates (a measure of physician work load) and documentation errors/omissions in both handwritten and dictated emergency treatment records. The study was carried out in two phases. Phase I examined handwritten records and Phase II examined dictated and transcribed records. A total of 838 charts for three common chief complaints (chest pain, abdominal pain, asthma/chronic obstructive pulmonary disease) were retrospectively reviewed and scored for the presence or absence of 11 predetermined criteria.
Jeffry P McKinzie, Seth W Wright, Keith D Wrenn
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90079-6
Published in issue: March 1997
xTo determine how often Food and Drug Administration (FDA)-approved age-specific prescribing guidelines were followed in pediatric emergency department (ED) patients, the charts for all children presenting to a university hospital pediatric ED during a 30-day period were reviewed. Of the 359 children who received drug therapy in the ED, 43% received one or more drugs not approved for use at the patients' respective ages. Of 296 children discharged with one or more prescriptions, 16% received a drug prescribed outside of FDA-approved guidelines based on age criteria.
Timothy Harrison, Stephen H Thomas, Suzanne K Wedel
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90080-2
Published in issue: March 1997
xThe purpose of this study was to determine whether pediatric trauma patients were transferred from community hospitals to trauma centers more expeditiously than adults of similar injury acuity. The study analyzed the air medical activation time, defined as the time delay between patient arrival at community hospitals and subsequent request for air medical transport to a Level I trauma center. Retrospective analysis of all interfacility air medical trauma transports by one service from October 1994 to June 1995 identified 40 pediatric and 156 adult patients.
Alan L Causey, Karen Seago, Nancy G Wahl, Cynthia L Voelker
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90081-4
Published in issue: March 1997
xA study was conducted to compare the presenting complaints and historical information of adolescents diagnosed as pregnant (DP) in the emergency department (ED) with adolescents seen in the ED who were pregnant and not diagnosed (MP). Medical records for the period 1980-94 were retrospectively analyzed to identify patients 16 years of age or younger who were diagnosed as pregnant in the ED or who had a live birth and had an ED visit during pregnancy. This analysis was done in a university-affiliated tertiary referral hospital with approximately 65,000 ED visits and 3,500 deliveries each year.
Anil K Mandal, Mohammad G Saklayen, Nosrat M Hillman, Ronald J Markert
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90082-6
Published in issue: March 1997
xHypernatremia (serum sodium level of > 145 mEq/L) is associated with high mortality. This study reports an analysis of mortality in 116 patients with hypernatremia from two large university-affiliated teaching hospitals. The purpose was to identify factors predictive of high mortality in hypernatremic patients. Medical records were reviewed to obtain the following data: serum sodium (Na+) levels; systolic (S) and diastolic (D) blood pressure (BP) at the time of admission and throughout the hospital course; status of cognitive function; and type of fluid administered.
Robert A Lowe, Andrew B Bindman
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90083-8
Published in issue: March 1997
xThe debate regarding risks and benefits of triaging nonurgent patients away from emergency departments (EDs) stems from widely varying estimates as to what proportion of ED visits are inappropriate. A study was undertaken based on the hypothesis that these discrepant estimates might be due to differences in how “appropriateness” is defined. This cross-sectional study included 596 ED patients. Seven different indicators of “inappropriate” ED visits were used. Two could be determined by the patient; two were based on the triage nurse's assessment; three were determined retrospectively, by chart review.
Brian R McMurray, Keith D Wrenn, Seth W Wright
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90084-X
Published in issue: March 1997
xTo evaluate the usefulness of blood cultures in patients admitted with pyelonephritis, a retrospective chart review was conducted of inpatients at a 594-bed urban, academic medical center from 1990 through 1992 with a primary discharge diagnosis of pyelonephritis. A total of 338 patients had this primary discharge diagnosis. One or more sets of blood cultures were obtained in 307 patients (91%). Fifty-six (18%) patients had a positive blood culture; 24 (32%) positive blood cultures grew coagulase-negative Staphylococcus species, in all but two instances considered a skin contaminant.
Richard F Salluzzo, Joel M Bartfield, Howard Freed, Mark Graber, Terry Peters
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90085-1
Published in issue: March 1997
xA telephone survey of a random sample of adult emergency department (ED) patients was conducted at a university health science center. The purpose of the study was to determine the opinion of ED patients concerning the risk of human immunodeficiency virus (HIV) transmission and their willingness to be treated by HIV-infected physicians and nurses. Surveys from 107 ED patients were compiled and available for analysis. Ninety percent of the respondents were tolerant of an HIV-infected physician or nurse (HIV + HCW) performing noninvasive procedures.
Peter C Ferrera, Lawrence E Kass
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90086-3
Published in issue: March 1997
xA 65-year-old man presented with an episode of loss of consciousness associated with a fever and headache. His history was significant for 1 year of short-term memory loss. Computed tomographic scanning showed a third ventricular mass that was ultimately resected and pathologically confirmed as a colloid cyst. The patient's postoperative course was complicated by a dense left hemiparesis. A brief discussion of colloid cysts of the third ventricle is presented.
Andy G Pinson, John T Philbrick, George H Lindbeck, John B Schorling
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90087-5
Published in issue: March 1997
xAcute pyelonephritis is a clinical syndrome that can be confused with other conditions. To investigate this problem, a retrospective cohort study was conducted using two mutually exclusive sets of clinical criteria for acute pyelonephritis in women 15 years of age or older who presented to the emergency department of a university hospital. All patients had pyuria, and one group had documented fever (temperature of ≥37.8°C) while the other group had a temperature of <37.8°C but had other evidence of possible upper tract infection.
Adam J Singer, Phyllis M Migdal, Jonathan P Oken, Stuart N Chale, Ute M Moll
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90088-7
Published in issue: March 1997
xA 55-year-old woman with stage IV-B nodular sclerosing Hodgkin's lymphoma presented to the emergency department with fever and lethargy of 12 hours' duration. The patient developed massive intravascular hemolysis secondary to Clostridium perfringens sepsis and cardiac arrest unresponsive to transfusions and cardiac pulmonary resuscitation, and died within 4 hours of presentation. The differential diagnosis of massive intravascular hemolysis, as well as the pathogenesis and treatment of C perfringens-induced hemolysis, are discussed.
Michael S Beeson, William A Schiavone
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90089-9
Published in issue: March 1997
xAcute myocardial infarction associated with ventricular septal defect (VSD) occurs infrequently. When a patient with an acquired VSD presents to the emergency department (ED), prompt recognition is required because definitive treatment can greatly decrease mortality. We present the case of a 75-year-old woman with an acute myocardial infarction and a new heart murmur. The diagnosis of acquired VSD was made by echocardiography in the ED, and emergency surgical correction was arranged.
Heather Prendergast, David Jerrard, Jeanne O'Connell
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90090-5
Published in issue: March 1997
xTwo cases of epidural abscess in afebrile intravenous drug abusers are presented. Both patients presented for evaluation of back pain that developed only after having moved heavy household items. One patient admitted to not having used intravenous drugs in at least 2 years. These cases are presented to illustrate the atypical fashion in which epidural abscess may present.
Robert McNamara, Thomas Koobatian
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90091-7
Published in issue: March 1997
xThe emergency physician must be aware of the varied ways in which epiglottitis can present. This report discusses two adult patients who presented with symptoms and signs indicative of uvulitis who were found to have associated epiglottitis. Neither patient reported respiratory difficulty but both experienced significant pain upon swallowing and were febrile with an enlarged, erythematous uvula. Management consisted of close observation and treatment with an intravenous antibiotic and corticosteroid.
James C Kolb, Lou Ann Woodward
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90092-9
Published in issue: March 1997
xA sexually transmitted disease is seldom considered in the differential diagnosis of patients with clinical gastritis. A patient with gastric syphilis is reported to alert emergency department physicians to this entity. History and physical findings of syphilis should be sought and rapid plasma reagin tests should be obtained in the patient with severe or refractory gastritis.
David Moon, Daniel Weeks, Brian Burgess, Robert O'Connor
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90093-0
Published in issue: March 1997
xPresentation of peptic ulcer disease in children covers a broad spectrum ranging from subtle, and thus overlooked and underdiagnosed, to catastrophic, as in this case. It is important for the emergency physician to realize the potential morbidity and mortality of this disease and be aware of the spectrum of presentation for primary and secondary pediatric ulcer disease.
Michael J Tueth
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90094-2
Published in issue: March 1997
xMany patients who seek emergency evaluation for recurrent chest pain have had negative cardiac evaluations, sometimes including normal coronary angiograms. Despite reassurance, many of these patients return to emergency departments with complaints of chest pain. Studies have shown that one third to one half of these patients suffer from panic disorder characterized by attacks of intense fear accompanied by chest pain or discomfort, nausea, and shortness of breath. If panic disorder is identified, it can be successfully treated.
Stephen L Adams, Paul R Yarnold
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90095-4
Published in issue: March 1997
xTo assess the reliability and validity of osteophony (patellar-public percussion [PPP] test) as a physical diagnostic sign in the evaluation of hip trauma, a prospective study was undertaken of 41 consecutive patients presenting to the emergency department with a history of hip trauma necessitating radiographic examination. Fifteen of 19 (78.9%) patients who presented with a history of hip trauma and a fracture on radiograph were found to have had an abnormal PPP sign by at least one of two raters (P < .0001).
Yung-Liang Wan, Kuei-Ton Tsai, Kee-Min Yeow, Chih-Feng Tan, Ho-Fai Wong
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90096-6
Published in issue: March 1997
xA case of right bronchial rupture demonstrated by computed tomography (CT) is reported. Chest radiographs of a 55-year-old man who sustained blunt chest trauma showed bilateral pneumomediastinum, hydropneumothorax, and subcutaneous emphysema with fracture of the left 3rd and 4th ribs. CT showed wall defect over the right main bronchus with the air in airway contiguous to that in the mediastinum. Bronchoscopy and thoracostomy confirmed the CT findings and the patient was treated by bronchorrhaphy with end-to-end anastomosis.
Tighe Zimmers
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90097-8
Published in issue: March 1997
Michael A Frakes, Lester E Richardson II
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90098-X
Published in issue: March 1997
xIntravenous magnesium has been suggested as a treatment for certain emergency conditions for more than 60 years. It is currently proposed to be beneficial in treating asthma, preeclampsia, eclampsia, myocardial infarction, and cardiac arrhythmias. The use and efficacy of the drug, however, are controversial. This article discusses the current state of magnesium sulfate research and therapy.
Jane Sharber
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90099-1
Published in issue: March 1997
xTepid sponge baths distress febrile children, and their efficacy at reducing fever has not been established. This study compared fever reduction and with (1) acetaminophen alone and (2) acetaminophen plus a 15-minute tepid sponge bath. Twenty children, ages 5 to 68 months, who presented to the emergency department or urgent care center with fever of ≥38.9°C were randomized to receive (1) acetaminophen alone or (2) acetaminophen plus a 15-minute tepid sponge bath. All subjects received a 15-mg/kg dose of acetaminophen.
Charles J McCabe, Ralph L Warren
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90100-5
Published in issue: March 1997
Kenneth V Iserson
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90101-7
Published in issue: March 1997
B.Tilman Jolly
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90102-9
Published in issue: March 1997
Larry B Mellick, Grace Kim
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90103-0
Published in issue: March 1997
Cecele M Goldman
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90104-2
Published in issue: March 1997
John M Howell
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90105-4
Published in issue: March 1997
Joseph P Ornato
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90106-6
Published in issue: March 1997
Eelco H Dykstra
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90107-8
Published in issue: March 1997
Francis L Counselman, Gregory R Davis
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90108-X
Published in issue: March 1997
Vivek Tayal
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90109-1
Published in issue: March 1997
William O Robertson
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90110-8
Published in issue: March 1997
Garyfallos T Garyfallou, Steven K Costalas, Christopher J Murphy
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90111-X
Published in issue: March 1997
Atul Kumar Gupta, Vikram S Dogra, Iftikhar Ahmad, Angelo M DelBalso
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90112-1
Published in issue: March 1997
Phillip Brottman, Douglas Propp, Craig Goldstein
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90113-3
Published in issue: March 1997
Rita Mrvos, Edward P Krenzelok
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90114-5
Published in issue: March 1997
Dan Schlager, David Whitten, Kimberly Tolan
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90115-7
Published in issue: March 1997
Deepak K Sachdeva, B.Tilman Jolly
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90116-9
Published in issue: March 1997
Hugh Montgomery, Saul Myerson
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90117-0
Published in issue: March 1997
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90118-2
Published in issue: March 1997
